Options for dealing with tooth decay
Not all tooth decay is created equal. Although some decay may require invasive drilling, in its early stages it may be addressed through less invasive means. In fact, there are a variety of minimally invasive interventions you and your dentist can use to tackle decay early.1 To help you partner with your dentist in this fight against decay, here is a rundown of what tooth decay is and how you can address it in its infancy.
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Early-Stage Decay
Teeth are covered with a thin film called plaque that contains bacteria. When you eat foods or drink beverages that have sugar in them, the bacteria produces acid. This acid causes tooth decay.
Tooth decay starts by softening the hard outer layer of your tooth called enamel. If it is not treated, it could become a cavity.
When tooth decay first begins, it can look brown or white. These are areas where the hard surface of your tooth, the enamel, is softening. At this point, you and your dentist may have some choices about how you want to manage this decay—to make sure it doesn’t get worse.
| TYPE OF TOOTH SURFACE | OPTION |
|---|---|
| Chewing Surface—Back Teeth | Sealants or sealants plus fluoride varnish† |
| Between Teeth | Fluoride varnish† |
| Surfaces Facing Lips, Cheeks, or Tongue | Fluoride gel† or fluoride varnish† |
| Exposed Root Surfaces (for Adults Only) | High-fluoride toothpaste‡ |
These are the most common options, but others may be available. Talk to your dentist about all of your options.
† Must be reapplied every 3 to 6 months.
‡ At-home use, once per day.
Topical fluoride treatments
Fluoride is a mineral found in nature that makes enamel stronger. You may already know that drinking fluoridated water helps prevent tooth decay. But there are also products that can be put right on teeth to help strengthen tooth enamel. Research shows that these products can help stop or even reverse early tooth decay.
Fluoride varnish
Fluoride varnish is a liquid that is painted onto the teeth. It hardens quickly into a thin layer, allowing the fluoride to be absorbed by the enamel. Fluoride varnish is quick and easy to apply. It can be a good option for patients who have difficulty sitting through treatments. On the downside, it can make your teeth look a little yellow. Although this yellowish color only lasts for a few hours, the protection offered by fluoride varnish lasts months. You will need to have it reapplied in about 3 to 6 months, depending on the schedule you and your dentist work out.
Fluoride gel
Fluoride gel is just that, a gel. It’s a quick way to get a fluoride treatment. A specially designed tray is filled with the gel, which is placed in your mouth against your teeth, during an office visit. You hold the tray in your mouth for a few minutes, allowing the enamel to absorb the fluoride, and then the tray is removed. Suction may be used to help prevent you from swallowing the gel because it can have an acidic taste and may upset your stomach.
Like fluoride varnish, fluoride gel generally needs to be applied every 3 to 6 months, depending on the plan developed by you and your dentist.
High-fluoride toothpaste
Everyone should always use toothpaste that contains fluoride. You can buy over-the-counter fluoride toothpaste in the store without a prescription, but some adults need toothpaste that is higher in fluoride, which requires a prescription. For instance, adults who have developed decay on exposed root surfaces can benefit from higher fluoride toothpaste. As you age, your gums may pull away from your teeth, leaving the root exposed. When decay strikes here, adults may be prescribed high-fluoride toothpaste to use daily to try to stop or reverse the decay.
Sealants
Sealants are a thin liquid coating applied to the chewing surfaces of your back teeth. These teeth have deep pits and grooves that can trap plaque and food particles, increasing the risk of developing tooth decay. The sealant hardens and covers the pits and grooves, helping keep the plaque and food out and protecting your teeth. Sealants have been shown to stop some early tooth decay.1
Sealants can be used alone or with a fluoride varnish. Sealants can last for months, but your dentist will need to see you at some point to check that the sealant is still covering the surface well.
Cavities
Once a tooth has a cavity, it may not be possible to reverse the tooth decay. But it is possible to stop more damage to the tooth. In some cases, you and your dentist may decide to remove the decay with a small drill (which will involve the loss of some enamel) and then fill that area of the tooth or cover it with a crown. Or you and your dentist may be able to consider an option that does not involve drilling into the tooth.
Silver diamine fluoride
Silver diamine fluoride (SDF) may be used in some cases to stop decay when a cavity has formed. With SDF, the dentist applies it directly to the area of decay without first having to drill the tooth. SDF is an inexpensive option that is simple to apply; however, although it stops the decay from progressing, it does not fill the cavity, and the tooth structure will remain weak if not restored with a filling or crown. Another drawback of SDF is that the color of the treated area will become black. This may be less of a problem in primary teeth, which will be lost as the child ages, than for permanent teeth. Even so, because applying SDF is quick, it may be especially helpful for patients who have trouble sitting still during dental treatments. SDF needs to be reapplied twice a year.
What Can You Do?
You play an important role in choosing how to manage tooth decay. If your dentist says you have tooth decay, ask questions. Ask him or her to explain how advanced the decay is and what your options are. Can the decay be stopped? Can it be reversed? What are the advantages of each approach? The disadvantages? Find out how much each option costs and if insurance will help pay for it. How often will you need to return to the dentist to see how well your tooth is doing? Don’t be afraid to ask these or any other questions that come to mind—you and your dentist are partners.
But you play an even bigger role in preventing future tooth decay and how well your treated teeth will fare. To take good care of your teeth every day, you should take these steps:
. brush your teeth with over-the-counter fluoride toothpaste twice a day;
. clean between your teeth daily with floss or another interdental cleaner;
. eat a healthy diet that limits sugary drinks and snacks;
. see your dentist regularly.
These steps are even more important if you are working with your dentist to stop or reverse tooth decay.
Conclusion
There are several ways to approach tooth decay. It doesn’t always have to be removed with a drill, which leaves the tooth to be filled or covered with a crown. Research shows that options exist that can help stop or, in some cases, reverse tooth decay. Talk to your dentist about these options as well as your own needs and preferences for dental care.
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